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GARFIELD BEACH CVS, L.L.C.
DSH050100 SHARP MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SHARP MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050100
Entity Address
7901 FROST STREET
SAN DIEGO, CA 92123
Medicare Provider Number
050100
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09138
1201 E. PLAZA BLVD
NATIONAL CITY, CA 91950
Pharmacy Comments
Contract Details
Approval Date
10/10/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TIM SMITH, CEO
(858) 939-4082
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/10/2016
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